View From Washington

Taking a Life Course Perspective on Advocacy

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP

It recently occurred to me that I have now spent almost the exact number of years working in health policy in our nation’s capital that I did in the state I grew up in (Hello Wisconsin!). This realization caused some soul searching moments, including a) how did I get so old so fast, b) have I become cynical, jaded and disillusioned, c) do I know any more about health policy and politics now than I did in 1994, and d) what happened to the hair I used to have and is my bald spot growing?

Especially today, the temptation to become discouraged is strong. Budget pressures seem more intense than ever, the divisiveness and uncertainty over the fate of health reform is potentially paralyzing, and new threats to critical program spring up faster than the dandelions in my yard.

In times like these, I remind myself of the power of optimism and relish the concept I learned of through Magda Peck, who I believe picked up on it from former CDC Director Dr. Bill Foege, who in turn credits former diplomat Harlan Cleveland with the observation that the field of public health is fueled by "unwarranted optimism." Dr. Foege is a true public health hero instrumental in the worldwide eradication of polio. He reminds us: "It is optimism that allows us to go beyond what seems to be possible." Incidentally, it was recently announced that Dr. Foege is being honored by President Obama with the Presidential Medal of Freedom, along with another of my heroes, Bob Dylan.

We are going to need this optimism as we embark on the wonderful potential of operationalizing life course theory into MCH policy and practice. As Amy Fine and Milt Kotelchuck (two more public health heroines/heroes in my book) acknowledge in their excellent treatise on life course, "Translating life course theory into concrete programs and policies is perhaps the most difficult of the life course challenges." I agree wholeheartedly with their assessment because the very essence of what operationalizing life course theory calls for – sustained, flexible funding that focuses on building systems rather than soloed disease or body-part-focused programs – is in direct opposition to how the U.S. Congress historically has funded public health efforts.

Two cases in point, we are all painfully too aware of how funding for the Title V MCH Services Block Grant has eroded in the past decade. More recently, the transformative potential of the Affordable Care Act Prevention and Public Health Fund is consistently derided by critics as a "slush fund" rather than the visionary investment in healthier communities and futures that it truly is.

Our central challenge, in my view, will be convincing policymakers of the need for adequate resources to address the factors life course theory illustrates are outside the direct influence of the health care system, such as socioeconomic status, environmental factors, racism, and access to adequate education, housing, and transportation. To be blunt, policymakers probably are not looking to health officials for recommendations on how to improve education or expand access to affordable housing, and that indeed may not be our main area of expertise. Yet, we know that these issues are fundamental to improving public health – maybe even more vital than ensuring access to health care. So we need to think carefully how health agencies and health officials can engage in this dialogue. We know we have a role to play in improving these systems and structures, but we need to make sure we frame it in a way that adds value and optimizes the multi-sector collaborations that the life course theory requires.